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Murthy V, Kashid SR, Vadassery A, Pal M, Maitre P, Arora A, Singh P, Menon S, Bakshi G, Joshi A, Prakash G. Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation. Int J Radiat Oncol Biol Phys 2023; 117:S112. [PMID: 37784294 DOI: 10.1016/j.ijrobp.2023.06.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Health-related Quality of life (HRQOL) may be decisive when different treatments yield comparable survival outcomes. We compared QOL in patients undergoing radical cystectomy with ileal conduit (RCIC) or bladder preservation (BP) with (chemo)radiotherapy for bladder cancer. MATERIALS/METHODS Patients with histological diagnosis of bladder cancer, stage T1-T4, N0-N1, M0 with a minimum follow-up of 6 months from the last treatment intervention (RCIC or BP) and alive without disease at the time of QOL assessment were eligible for inclusion. After ethics committee approval, two HRQOL instruments were translated, validated and administered: Bladder cancer index (BCI) for bladder cancer-specific HRQOL, which includes 36 items under three domains - bladder, bowel and sexual function and the EORTC QLQ C30 which includes 30 items under three domains - functional, symptom and global health. The mean QOL scores across various domains and specific questions were compared between the two treatment groups using the independent t-test. RESULTS Of the 104 patients enrolled, 56 had RCIC, and 48 received BP, and included 95 (91.3%) males. The median time from treatment completion to QOL assessment was 22 months (IQR 10-56). The median age for the entire cohort was 62 years (IQR 55-68), 65.5 years (IQR 55-71) in BP and 59.5 years (IQR 55-66) in RCIC. Overall, mean BCI urinary scores and bowel scores were high in both groups, with no significant difference in function or bother subdomains between the two groups (Table 1). Overall, BCI sexual scores were low in both the groups but significantly better after BP (BPmean 56.9, RCICmean 41.5, p = 0.01). Mean scores for sexual function BPmean 38.4 and RCIC mean 25 p (0.07) and sexual bother BPmean 81 RCICmean 62 (p 0.02) subdomains. There was no significant difference in EORTC QOL outcomes in functional (BPmean 91.4, RCICmean 88.7 p 0.23), symptom (BPmean 89.8, RCICmean 89, p = 0.68) and global health scale (BPmean 76.8, RCICmean 78.5, p = 0.69) in both groups. On question-wise assessment, the ability to perform an exercise (BPmean 94.2, RCICmean 85, p = 0.06) and urinary leakage at night time (BPmean 91.7, RCICmean 77.6, p = 0.01) were better in the BP group, while scores for blood in the urine (BPmean 89.1, RCICmean 97, p = 0.05) were better in the RCIC group compared to BP. CONCLUSION Overall, QOL was good in both groups in the urinary and bowel domains while it was low in the sexual domain. However, bladder preservation performed significantly better in the sexual domain than RCIC.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S R Kashid
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - A Vadassery
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Arora
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - P Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Murthy V, Maitre P, Singh M, Pal M, Arora A, Pujari L, Kapoor A, Pandey H, Sharma R, Gudipudi D, Joshi A, Prabhash K, Noronha V, Menon S, Mehta P, Bakshi G, Prakash G. Study Protocol of the Bladder Adjuvant RadioTherapy (BART) Trial: A Randomised Phase III Trial of Adjuvant Radiotherapy Following Cystectomy in Bladder Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e506-e515. [PMID: 37208232 DOI: 10.1016/j.clon.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
AIMS To assess the efficacy and safety of adjuvant radiotherapy in patients with high-risk muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC) and chemotherapy. MATERIALS AND METHODS The BART (Bladder Adjuvant RadioTherapy) trial is an ongoing multicentric, randomised, phase III trial comparing the efficacy and safety of adjuvant radiotherapy versus observation in patients with high-risk MIBC. The key eligibility criteria include ≥pT3, node-positive (pN+), positive margins and/or nodal yield <10, or, neoadjuvant chemotherapy for cT3/T4/N+ disease. In total, 153 patients will be accrued and randomised, in a 1:1 ratio, to either observation (standard arm) or adjuvant radiotherapy (test arm) following surgery and chemotherapy. Stratification parameters include nodal status (N+ versus N0) and chemotherapy (neoadjuvant chemotherapy versus adjuvant chemotherapy versus no chemotherapy). For patients in the test arm, adjuvant radiotherapy to cystectomy bed and pelvic nodes is planned with intensity-modulated radiotherapy to a dose of 50.4 Gy in 28 fractions using daily image guidance. All patients will follow-up with 3-monthly clinical review and urine cytology for 2 years and subsequently 6 monthly until 5 years, with contrast-enhanced computed tomography abdomen pelvis 6 monthly for 2 years and annually until 5 years. Physician-scored toxicity using Common Terminology Criteria for Adverse Events version 5.0 and patient-reported quality of life using the Functional Assessment of Cancer Therapy - Colorectal questionnaire is recorded pre-treatment and at follow-up. ENDPOINTS AND STATISTICS The primary endpoint is 2-year locoregional recurrence-free survival. The sample size calculation was based on the estimated improvement in 2-year locoregional recurrence-free survival from 70% in the standard arm to 85% in the test arm (hazard ratio 0.45) using 80% statistical power and a two-sided alpha error of 0.05. Secondary endpoints include disease-free survival, overall survival, acute and late toxicity, patterns of failure and quality of life. CONCLUSION The BART trial aims to evaluate whether contemporary radiotherapy after standard-of-care surgery and chemotherapy reduces pelvic recurrences safely and also potentially affects survival in high-risk MIBC.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Arora
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Pujari
- Department of Radiation Oncology, HBCH & MPMMMC, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, HBCH & MPMMMC, Varanasi, India
| | - H Pandey
- Department of Surgical Oncology, HBCH & MPMMMC, Varanasi, India
| | - R Sharma
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - D Gudipudi
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mehta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Hamm SE, Yuan C, McQueen LF, Wallace MA, Zhang H, Arora A, Garafalo AM, McMillan RP, Lawlor MW, Prom MJ, Ott EM, Yan J, Addington AK, Morris CA, Gonzalez JP, Grange RW. Prolonged voluntary wheel running reveals unique adaptations in mdx mice treated with microdystrophin constructs ± the nNOS-binding site. Front Physiol 2023; 14:1166206. [PMID: 37435312 PMCID: PMC10330712 DOI: 10.3389/fphys.2023.1166206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 07/13/2023] Open
Abstract
We tested the effects of prolonged voluntary wheel running on the muscle function of mdx mice treated with one of two different microdystrophin constructs. At 7 weeks of age mdx mice were injected with a single dose of AAV9-CK8-microdystrophin with (gene therapy 1, GT1) or without (gene therapy 2, GT2) the nNOS-binding domain and were assigned to one of four gene therapy treated groups: mdxRGT1 (run, GT1), mdxGT1 (no run, GT1), or mdxRGT2 (run,GT2), mdxGT2 (no run, GT2). There were two mdx untreated groups injected with excipient: mdxR (run, no gene therapy) and mdx (no run, no gene therapy). A third no treatment group, Wildtype (WT) received no injection and did not run. mdxRGT1, mdxRGT2 and mdxR performed voluntary wheel running for 52 weeks; WT and remaining mdx groups were cage active. Robust expression of microdystrophin occurred in diaphragm, quadriceps, and heart muscles of all treated mice. Dystrophic muscle pathology was high in diaphragms of non-treated mdx and mdxR mice and improved in all treated groups. Endurance capacity was rescued by both voluntary wheel running and gene therapy alone, but their combination was most beneficial. All treated groups increased in vivo plantarflexor torque over both mdx and mdxR mice. mdx and mdxR mice displayed ∼3-fold lower diaphragm force and power compared to WT values. Treated groups demonstrated partial improvements in diaphragm force and power, with mdxRGT2 mice experiencing the greatest improvement at ∼60% of WT values. Evaluation of oxidative red quadriceps fibers revealed the greatest improvements in mitochondrial respiration in mdxRGT1 mice, reaching WT levels. Interestingly, mdxGT2 mice displayed diaphragm mitochondrial respiration values similar to WT but mdxRGT2 animals showed relative decreases compared to the no run group. Collectively, these data demonstrate that either microdystrophin construct combined with voluntary wheel running increased in vivo maximal muscle strength, power, and endurance. However, these data also highlighted important differences between the two microdystrophin constructs. GT1, with the nNOS-binding site, improved more markers of exercise-driven adaptations in metabolic enzyme activity of limb muscles, while GT2, without the nNOS-binding site, demonstrated greater protection of diaphragm strength after chronic voluntary endurance exercise but decreased mitochondrial respiration in the context of running.
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Affiliation(s)
- S. E. Hamm
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - C. Yuan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - L. F. McQueen
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - M. A. Wallace
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - H. Zhang
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. Arora
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. M. Garafalo
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - R. P. McMillan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - M. W. Lawlor
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - M. J. Prom
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - E. M. Ott
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - J. Yan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. K. Addington
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - C. A. Morris
- Solid Biosciences, Inc., Cambridge, MA, United States
| | | | - R. W. Grange
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
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Gurumurthy S, Arora A, Krishna H, Chinnusamy V, Hazra KK. Genotypic capacity of post-anthesis stem reserve mobilization in wheat for yield sustainability under drought and heat stress in the subtropical region. Front Genet 2023; 14:1180941. [PMID: 37408776 PMCID: PMC10318140 DOI: 10.3389/fgene.2023.1180941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
Wheat productivity is severely affected by drought and heat stress conditions worldwide. Currently, stem reserve mobilization (SRM) is receiving increased attention as a trait that can sustain wheat yields under adverse environments. However, the significance of SRM in sustaining wheat yields under drought and heat stress conditions remains uncertain in the tropical climate of Indo-Gangetic Plain region. Therefore, this study aimed to investigate genotypic variations in SRM in wheat and their influence on yield sustainability under drought and heat stress environments. The experiment was designed in an alpha-lattice layout, accommodating 43 genotypes under four simulated environments [timely sown and well irrigated (non-stress); timely sown and water-deficit/drought stress; late-sown and well-irrigated crop facing terminally high temperature; and late-sown and water-deficit stress (both water-deficit and heat stress)]. The water-deficit stress significantly increased SRM (16%-68%, p < 0.01) compared to the non-stress environment, while the heat stress conditions reduced SRM (12%-18%). Both SRM and stem reserve mobilization efficiency exhibited positive correlations with grain weight (grain weight spike-1) under all three different stress treatments (p < 0.05). Strong positive correlations between stem weight (at 12 days after anthesis) and grain weight were observed across the environments (p < 0.001); however, a significant positive correlation between stem weight and SRM was observed only with stress treatments. Results revealed that the SRM trait could effectively alleviate the impacts of water-deficit stress on yields. However, the SRM-mediated yield protection was uncertain under heat stress and combined water-deficit and heat stress treatments, possibly due to sink inefficiencies caused by high temperature during the reproductive period. Defoliated plants exhibited higher SRM than non-defoliated plants, with the highest increment observed in the non-stress treatment compared to all the stress treatments. Results revealed that wider genetic variability exists for the SRM trait, which could be used to improve wheat yield under drought stress conditions.
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Affiliation(s)
- S. Gurumurthy
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
- School of Water Stress Management, ICAR–National Institute of Abiotic Stress Management, Baramati, Maharashtra, India
| | - A. Arora
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - Hari Krishna
- Division of Genetics, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - V. Chinnusamy
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - K. K. Hazra
- Crop Production Division, ICAR–Indian Institute of Pulses Research, Kanpur, Uttar Pradesh, India
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Swann JR, Diaz Heijtz R, Mayneris-Perxachs J, Arora A, Isaksson J, Bölte S, Tammimies K. Characterizing the metabolomic signature of attention-deficit hyperactivity disorder in twins. Neuropharmacology 2023; 234:109562. [PMID: 37100381 DOI: 10.1016/j.neuropharm.2023.109562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/05/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023]
Abstract
Emerging evidence implicate the gut microbiota as a potential susceptibility factor in attention-deficit hyperactivity disorder (ADHD), a common multifactorial neurodevelopmental condition. However, little is known about the biochemical signature of ADHD, including the metabolic contribution of the microbiota via the gut-brain axis, and the relative contribution of genetics and environmental factors. Here, we perform unbiased metabolomic profiling of urine and fecal samples collected from a well-characterized Swedish twin cohort enriched for ADHD (33 ADHD, 79 non-ADHD), using 1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry. Our results highlight sex-specific patterns in the metabolic phenotype of individuals with ADHD. Specifically, the urine profile of males, but not females, with ADHD was characterized by greater excretion of hippurate, a product of microbial-host co-metabolism that can cross the blood-brain-barrier with bioactivity of potential relevance to ADHD. This trans-genomic metabolite was also negatively correlated with IQ in males and was significantly correlated with fecal metabolites associated with gut microbial metabolism. The fecal profile of ADHD individuals was characterized by increased excretion of stearoyl-linoleoyl-glycerol, 3,7-dimethylurate, and FAD and lower amounts of glycerol 3-phosphate, thymine, 2(1H)-quinolinone, aspartate, xanthine, hypoxanthine, and orotate. These changes were independent of ADHD medication, age, and BMI. Furthermore, our specific twins' models revealed that many of these gut metabolites had a stronger genetic influence than environmental. These findings suggest that metabolic disturbances in ADHD, involving combined gut microbial and host metabolic processes, may largely derive from gene variants previously linked to behavioral symptoms in this disorder.
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Affiliation(s)
- J R Swann
- School of Human Development and Health, Faculty of Medicine, University of Southampton, UK; Department of Metabolism, Digestion, and Reproduction, Faculty of Medicine, Imperial College London, UK.
| | - R Diaz Heijtz
- Department of Neuroscience, Karolinska Institutet Region Stockholm, Stockholm, Sweden
| | - J Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute, Girona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - A Arora
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden
| | - J Isaksson
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - S Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - K Tammimies
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden
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Cheng AP, Widman AJ, Arora A, Rusinek I, Hooper WF, Murray R, Halmos D, Langanay T, Inghirami G, Germer S, Marton M, Helland A, Furatero R, McClintock J, Winterkorn L, Steinsnyder Z, Wang Y, Rajagopalan S, Alimohamed AI, Malbari MS, Saxena A, Callahan MK, Frederick DT, Spain L, Jaimovich A, Lipson D, Turajlic S, Zody MC, Altorki NK, Wolchok JD, Postow MA, Robine N, Boland G, Landau DA. Abstract 5709: Whole genome error-corrected sequencing for sensitive circulating tumor DNA cancer monitoring. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
In many areas of oncology, we lack sensitive tumor-burden monitoring to guide critical decision making. While circulating tumor DNA (ctDNA) promises to enable disease monitoring, this approach is limited by the sparsity of ctDNA in the plasma. To overcome this challenge, error-corrected deep targeted sequencing has been proposed.
Nonetheless, this framework is limited by the low number of genomic equivalents (GEs, ~103/mL of plasma), imposing a ceiling on effective sequencing depth. We have previously shown that genome-wide mutational integration through plasma whole genome sequencing (WGS) can sever the dependency between available GEs and assay sensitivity (Zviran et al, 2020). In this approach, tumor-informed mutational profiles are applied to plasma WGS, allowing detection of tumor fractions as low as 10−5. However, the higher cost of WGS limits practical depth of coverage (20-30X) and may limit broad adoption. Lower costs may thus allow for enhanced ctDNA cancer monitoring via WGS. We therefore applied emerging lower-cost WGS (1USD/Gb, Almogy et al, 2022) to plasma from 7 patients with metastatic cancer at ~115x coverage depth. Read depth profiling and error rates were comparable between matched Ultima and standard platform datasets. Integration of deep learning architectures for signal to noise enrichment (Widman et al, biorxiv, 2022) with deeper WGS coverage enabled ctDNA detection at the parts per million range.
We reasoned that lower sequencing cost can be harnessed for duplex error-corrected WGS. Proof-of-concept experiments in mouse PDX samples showed ~1,500x decrease in errors. Applied to the plasma of stage IV melanoma patients (n=5), we obtained error rates ~10−7. We used this approach to tackle the challenging context of cancer monitoring in early-stage melanoma without matched tumor sequencing. While in uncorrected WGS, de novo mutation calling yielded limited ability to detect melanoma specific mutations, duplex-corrected WGS allowed us to harness melanoma mutational signatures for disease monitoring without matched tumor profiling. Analytic validation of our assay showed sensitive and specific cancer detection when the concentration of ctDNA was at 10−4 concentrations. Applied to a cohort of stage III melanoma patients with negative ctDNA detection using previously described methods, we detected ctDNA in all cases (n=4), demonstrating enhanced sensitivity using duplex WGS. These data demonstrate the exciting potential of low cost WGS for ultra-sensitive ctDNA cancer monitoring. In the tumor-informed setting, deeper sequencing increased sensitivity for mutational profile detection. Moreover, the application of duplex error-correction at genome scale allowed for sensitive cancer monitoring without matched tumor profiles. We envision that the era of low-cost sequencing will empower ultra-sensitive cancer monitoring via WGS, with transformative impact on cancer care.
Citation Format: Alexandre P. Cheng, Adam J. Widman, Anushri Arora, Itai Rusinek, William F. Hooper, Rebecca Murray, Daniel Halmos, Theophile Langanay, Giorgio Inghirami, Soren Germer, Melissa Marton, Adrienne Helland, Rob Furatero, Jaime McClintock, Lara Winterkorn, Zoe Steinsnyder, Yohyoh Wang, Srinivas Rajagopalan, Asrar I. Alimohamed, Murtaza S. Malbari, Ashish Saxena, Margaret K. Callahan, Dennie T. Frederick, Lavinia Spain, Ariel Jaimovich, Doron Lipson, Samra Turajlic, Michael C. Zody, Nasser K. Altorki, Jedd D. Wolchok, Michael A. Postow, Nicolas Robine, Genevieve Boland, Dan A. Landau. Whole genome error-corrected sequencing for sensitive circulating tumor DNA cancer monitoring. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5709.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yohyoh Wang
- 1Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | - Lavinia Spain
- 7The Francis Crick Institute, London, United Kingdom
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Hussain RN, Chiu A, Pittam B, Taktak A, Damato BE, Kacperek A, Errington D, Cauchi P, Chadha V, Connolly J, Salvi S, Rundle P, Cohen V, Arora A, Sagoo M, Bekir O, Kopsidas K, Heimann H. Proton beam radiotherapy for choroidal and ciliary body melanoma in the UK-national audit of referral patterns of 1084 cases. Eye (Lond) 2023; 37:1033-1036. [PMID: 35840716 PMCID: PMC10050435 DOI: 10.1038/s41433-022-02178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Proton beam therapy has been utilised for the treatment of uveal melanoma in the UK for over 30 years, undertaken under a single centre. In the UK, all ocular tumours are treated at one of four centres. We aimed to understand the variation in referral patterns to the UK proton service, capturing all uveal melanoma patients treated with this modality. METHODS Retrospective analysis of data regarding all patients treated at the Clatterbridge Proton service between January 2004 and December 2014. RESULTS A total of 1084 patients with uveal melanoma were treated. The mean age was 57 years (range 9-90 years), basal diameter of 11.5 mm (range 2.0-23.4 mm) and tumour thickness of 3.9 mm (range 0.1-15.4 mm). The majority were TNM stage I (39%) or II (36%). The distance to the optic nerve varied from 0 to 24.5 mm with 148 (14%) of patients having ciliary body involvement. There were variations in the phenotypic characteristic of the tumours treated with protons from different centres, with London referring predominantly small tumours at the posterior pole, Glasgow referring large tumours often at the ciliary body and Liverpool sending a mix of these groups. DISCUSSION In the UK, common indications for the use of proton treatment in uveal melanoma include small tumours in the posterior pole poorly accessible for plaque treatment (adjacent to the disc), tumours at the posterior pole affecting the fovea and large anterior tumours traditionally too large for brachytherapy. This is the first UK-wide audit enabling the capture of all patients treated at the single proton centre.
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Affiliation(s)
- R N Hussain
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK.
| | - A Chiu
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - B Pittam
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - A Taktak
- Department of Eye and Vision Science and Department of Biostatistics, University of Liverpool, Liverpool, L69 3GL, UK
| | - B E Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Kacperek
- University College London, London, WC1E 6BT, UK
| | - D Errington
- Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JY, UK
| | - P Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - V Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - J Connolly
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - S Salvi
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - P Rundle
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - V Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - M Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - O Bekir
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - K Kopsidas
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - H Heimann
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
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8
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Prakash G, Chandankhede U, Nadkarni S, Pal M, Arora A, Gujela A, Bakshi G. The Belly-Up technique for pericaval nodal dissection in RPLND - Saving caval resections and reconstructions. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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9
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Menon S, Shah A, Sali A, Prakash G, Bakshi G, Pal M, Joshi A, Murthy V, Maitre P, Arora A, Desai S. Concordance of histological grade between pre-operative biopsy and resection specimen in penile squamous cell carcinoma. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Kumar M, Arora A, Kumar M. P-138 PREDICTORS OF COMPLICATIONS IN COMPLEX VENTRAL HERNIA REPAIR USING POSTERIOR COMPONENT SEPARATION TECHNIQUE WITH RETRO RECTUS MESH PLACEMENT – AN OBSERVATIONAL STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Incisional Hernia has an incidence ranging from 2–20%. Large and complex incisional hernias are difficult to treat with standard procedures. PCS-TAR is a relatively novel procedure. There persists a gap in knowledge regarding its outcomes, especially in the Indian population.
Aims & Objective
To identify the pre-operative clinical and radiological factors that predict the risk of re-herniation and wound and mesh-related complications after CVH (Complex Ventral Hernia)
Methodology
In a prospective observational study, patients undergoing open PCS-TAR with retro rectus mesh for Complex Ventral Hernia repair included in the study. The patient demographics, hernia characteristics, radiological details, operative data, post- operative outcomes, and follow-up data were entered in a pre-designed proforma. Data were analyzed with SPSS softwere.
Results
35 patients with CVH were included, of which 30 (85%) women and 5 men. The mean age was 51.8 years and the mean BMI was 29.7 kg/m2. The mean size of defect was 12 cm. 83% hernia were midline primary and 255 were recurrent hernias. We observed zero recurrences at six months of follow-up, but a high wound morbidity rate of up to 49%, of which most common was seroma formation. 23% of patients developed SSI.
Conclusion
In conclusion, PCS-TAR is a promising novel procedure for complex ventral hernias not amenable to primary closure using the traditional retro rectus approach, with excellent short term outcomes. Wound morbidity is a significant concern with this procedure, which can be prevented or reduced by thorough pre-operative optimization on a case-to-case basis.
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Affiliation(s)
- M Kumar
- General Surgery, AIIMS Patna , Patna , India
| | - A Arora
- General Surgery, AIIMS Patna , Patna , India
| | - M Kumar
- General Surgery, AIIMS Patna , Patna , India
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11
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Lamarca A, Palmer D, Wasan H, Ross P, Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maravellas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. 54MO Quality of life (QoL) and value of health (V-He) in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+FOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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12
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Arora A, Kivelä A, Taskinen J, Raiborg C, Olkkonen V. Role of Protrudin in endothelial cell function. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Arora A, Storr SJ, Reddy H, Lobo DN, Madhusudan S, Zaitoun AM. O085 CD10 expression in carcinomas of the pancreas, bile duct and ampulla. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
Pancreatic cancer and cholangiocarcinoma including, cancer of ampulla of Vater, are very aggressive and have a dismal prognosis; hence improved methods of patient stratification are required.
Methods
We assessed the expression of CD10 in stromal and epithelial cells of two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla.
Results
In bile duct and ampullary carcinomas an association was observed between CD10 stromal expression and patient age (p =0.009). The CD10 stromal expression was associated with poor disease specific survival (DSS) (p =0.05). In multivariate Cox model for DSS, stromal CD10 expression (p = 0.037) was independently associated with poor outcome. In multivariate Cox model for disease free survival (DFS), CD10 stromal expression (p = 0.012), and nodal status (p = 0.025) were independently associated with poor outcome. In pancreatic cancer, no statistically significant association was observed between CD 10 stromal expression and clinicopathological variables such as tumour size (p = 0.099), T stage (p = 0.393), N stage (p = 0.860), Vascular invasion (p = 0.904), perineural invasion (p = 0.532) and grade (0.168). In multivariate Cox model for DSS, T stage (p = 0.042) was independently associated with poor outcome.
Conclusion
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
Take-home message
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
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Affiliation(s)
- A Arora
- Nottingham University Hospitals NHS Foundation Trust
| | - SJ Storr
- Nottingham University Hospitals NHS Foundation Trust
| | - H Reddy
- Nottingham University Hospitals NHS Foundation Trust
| | - DN Lobo
- Nottingham University Hospitals NHS Foundation Trust
| | - S Madhusudan
- Nottingham University Hospitals NHS Foundation Trust
| | - AM Zaitoun
- Nottingham University Hospitals NHS Foundation Trust
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14
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Lamarca A, Palmer D, Wasan H, Ross P, Ting Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maraveyas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. P-88 Clinical role of tumour markers in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+mFOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Ha DH, Arora A, Harford J, Luzzi L, Chrisopoulos S, Do LG. Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children. JDR Clin Trans Res 2022:23800844221091701. [PMID: 35466760 DOI: 10.1177/23800844221091701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.
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Affiliation(s)
- D H Ha
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia.,Health Equity Laboratory, Campbelltown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Westmead, NSW, Australia
| | - J Harford
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - L Luzzi
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - S Chrisopoulos
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - L G Do
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
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16
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Affiliation(s)
- A Arora
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
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17
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Arora A, Arkle T, Sreedharan L, Kumar B. 60 Neoadjuvant Imatinib Mesylate – an Ace of Spaces for Surgical Management of an Oesophago-Gastric Junction Gastro-Intestinal Stromal Tumour. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Oesophageal gastro-intestinal stromal tumours (GISTs) are rare, accounting for less than five percent of all GIST, with the majority of these occurring at the oesophago-gastric junction (OGJ). Due to the anatomical location and size of these tumours at presentation, surgical resection is often a major undertaking.
Neoadjuvant treatment with tyrosine kinase inhibitors, such as Imatinib mesylate, have the potential to downstage such tumours, thereby limiting the extent of subsequent surgical resection. This may therefore reduce any potentially associated morbidity and mortality.
Case Description
We report the case of a 75-year-old gentleman who presented with a large OGJ GIST, which presented with dysphagia. The tumour was deemed too large for local excision due to the risk of compromising the lumen at the OGJ in attempting to obtain a clear resection margin. Given the patient’s co-morbidity, oesophagectomy or total gastrectomy was deemed too major an undertaking. Therefore, endoscopic biopsies were obtained with a view to possible neoadjuvant therapy. These confirmed DOG-1 and Exon-11 mutations, suggesting sensitivity to Imatinib mesylate. A standard dose regime of 400mg daily for a planned 36-month course was commenced. Subsequent imaging showed a substantial decrease in tumour bulk and the decision was made to perform a local excision. A local enucleation procedure was performed, and the patient made a sound recovery.
Post-operative histology of resected tumour showed almost complete tumour regression.
Discussion
This significant response to neoadjuvant Imatinib mesylate therapy demonstrates clear potential for its use in similar cases, where radical resection would cause significant morbidity and risk mortality.
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Affiliation(s)
- A. Arora
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - T. Arkle
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - L. Sreedharan
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - B. Kumar
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
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18
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Chandankhede U, Arora A, Prakash G, Pal M, Tummala M, Mohan A, Bakshi G. Outcomes of penile cancer stratified by nodal staging: Importance of pelvic nodal involvement. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Arora A, Prakash G, Pal M, Chandankhede U, Tummala M, Mohan A, Bakshi G, Chandankhede U, Chandankhede U. Patterns of recurrence in penile cancer: Implications for surveillance strategies. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Kalra M, Bakhshi S, Singh M, Seth R, Verma N, Jain S, Radhakrishnan V, Mandal P, Mahajan A, Arora R, Dinand V, Kapoor G, Sajid M, Thulkar S, Arora A, Taluja A, Chandra J. PET-CT vs CECT for response assessment in childhood Hodgkin Lymphoma - Subset analysis of InPOG HL-15-01 study. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Eapen V, Woolfenden S, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Cibralic S, Winata T, Mendoza Diaz A, Lam-Cassettari C, Burley J, Boydell K, Lin P, Masi A, Katz I, Dadich A, Preddy J, Bruce J, Raman S, Kohlhoff J, Descallar J, Karlov L, Kaplun C, Arora A, Di Mento B, Smead M, Doyle K, Grace R, McClean T, Blight V, Wood A, Raine KH. "Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol. BMC Health Serv Res 2021; 21:1240. [PMID: 34789234 PMCID: PMC8596348 DOI: 10.1186/s12913-021-07243-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) – developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents’ mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the ‘care-as-usual’ group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and ‘warm hand over’ by a ‘service navigator’ to ensure their needs are met. Methods Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the ‘care-as-usual’ or ‘intervention’ group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. Conclusions Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. Trial registration The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- V Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,South Western Sydney Local Health District, Liverpool, Australia.
| | - S Woolfenden
- Sydney Children's Hospital Randwick, Randwick, Australia
| | - V Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - B Jalaludin
- South Western Sydney Local Health District, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - K Lawson
- School of Business, Western Sydney University, Sydney, Australia
| | - S T Liaw
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - R Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - A Page
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - S Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - T Winata
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C Lam-Cassettari
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Burley
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - K Boydell
- Black Dog Institute, Sydney, Australia
| | - P Lin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,South Western Sydney Local Health District, Liverpool, Australia
| | - A Masi
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - I Katz
- Social Policy Research Centre, Faculty of Arts, Design, & Architecture, University of New South Wales, Sydney, Australia
| | - A Dadich
- School of Business, Western Sydney University, Sydney, Australia
| | - J Preddy
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - J Bruce
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - S Raman
- South Western Sydney Local Health District, Liverpool, Australia
| | - J Kohlhoff
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Karitane, Carramar, Australia
| | - J Descallar
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - L Karlov
- South Western Sydney Local Health District, Liverpool, Australia
| | - C Kaplun
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - B Di Mento
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Smead
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - K Doyle
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - R Grace
- TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | | | - V Blight
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Wood
- Karitane, Carramar, Australia
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Kumar S, Ashok V, Jain D, Arora A, Singh A, Sikka P. Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after elective caesarean delivery in a developing country: a prospective observational study. Int J Obstet Anesth 2021; 49:103235. [PMID: 34810053 DOI: 10.1016/j.ijoa.2021.103235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11. METHODS In this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility. RESULTS The Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P <0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P <0.0001). The reliability and internal consistency were moderate (Cronbach's alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P <0.0001) and no floor or ceiling effects. All parturients completed the questionnaire (median (IQR) time of completion of 3 (1.5 - 5.5) min). CONCLUSION The Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India, as well as in other languages.
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Affiliation(s)
- S Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - V Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India.
| | - D Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Arora
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Singh
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - P Sikka
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
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23
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Arshad Z, Maughan HD, Pettit MH, Kumar KHS, Arora A, Khanduja V. 1300 Version Abnormalities of the Femur and Acetabulum in Patients with Femoroacetabular Impingement: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
This systematic review aims to understand the relationship between version abnormalities of the femur and acetabulum in patients with primary and secondary femoroacetabular impingement (FAI).
Method
A systematic review was conducted according to PRISMA guidelines. A computer-based search was performed using the EMBASE, MEDLINE, PubMed and Cochrane databases for articles relating to version and torsional abnormalities in FAI, Legg-Calve-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). The study was registered in the Open Science Framework. Two authors independently performed title/abstract and full text screening according to predetermined inclusion criteria.
Results
A total of 1206 articles were identified 55 articles, involving 10, 091 hips, met the inclusion criteria. All studies evaluating femoral/acetabular version in FAI reported ‘normal’ mean version values (10o to 25o). However, distribution analysis revealed that an estimated 31.4% and 51.3% of patients with FAI displayed abnormal acetabular and femoral version, respectively. Abnormal femoral version was reported in an estimated 74.5% of hips with LCPD, and abnormal acetabular version in an estimated 20%. Acetabular version was significantly lower in hips with SCFE compared to controls (Z=-3.26, P < 0.01).
Conclusions
Patients presenting with hip pain attributed to FAI are likely to display an abnormality in femoral or acetabular version. This highlights the importance of evaluating these parameters during assessment of these patients, in order to guide clinical decision making.
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Affiliation(s)
- Z Arshad
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - H D Maughan
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - M H Pettit
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - K H S Kumar
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - A Arora
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - V Khanduja
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.
Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.
Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).
Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - R De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - A Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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25
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Arora A, Raffaele A, Agarwala S, Parigi GB, Manzoni F, Klersy C, Bhatnagar V. 1124 Is Delayed Presentation A Prognostic Factor for The Survival of Patients with Esophageal Atresia More Than Associated Anomalies? Comparison Between Different Social Realities. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The aim is to evaluate if different social reality could represent a prognostic factor as associated anomalies affecting survival of neonates with esophageal atresia (EA).
Method
Retrospective analysis of records of neonates with EA with or without Tracheoesophageal Fistula (TEF) from January 2011 to September 2018 at Policlinico San Matteo Pavia, Italy(SMAT) and the All India Institute of Medical Sciences New Delhi, India (AIIMS).Survival was correlated with the presence of anomalies, different types and the number of organ systems involved.Age at presentation and birth weight were considered to find an association with mortality.
Results
Out of 180 patients,162 were from AIIMS and 18 from SMAT.The overall mortality was 28.85%, which occurred at AIIMS, being 0% at SMAT.83.33% at SMAT and 72.84% at AIIMS had associated anomalies.The mortality was 25% for neonates without an anomaly, being 26.15% for those with one (p > 0.05).No statistically significant correlation between outcome and associated anomalies was found.Instead, survival declines gradually as the age at presentation increases.
Conclusions
The presence of associated anomalies paradoxically does not affect the outcome because incidence of delayed presentation has a stronger effect than the presence of associated anomalies. Sensibilization is necessary to improve survival in EA neonates in developing countries, such as India.
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Affiliation(s)
- A Arora
- Università Degli Studi di Pavia, Pavia, Italy
| | - A Raffaele
- Università Degli Studi di Pavia, Pavia, Italy
| | - S Agarwala
- All India Institute of Medical Sciences, New Delhi, India
| | - G B Parigi
- Università Degli Studi di Pavia, Pavia, Italy
| | - F Manzoni
- Università Degli Studi di Pavia, Pavia, Italy
| | - C Klersy
- Università Degli Studi di Pavia, Pavia, Italy
| | - V Bhatnagar
- All India Institute of Medical Sciences, New Delhi, India
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26
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Kathiravelupillai A, Arora A, Jeannon JP, Brunet-Garcia A, Faulkner J, Sandison A. 1079 Analysis of Human Papilloma Virus (HPV) Status in Metastatic Oropharyngeal Squamous Cell Carcinoma (OPSCC). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
OPSCC often (80%) presents with ipsilateral neck metastasis. Presentation may be as carcinoma of unknown primary (CUP). Sampling via ultrasound guided Fine Needle Aspiration Cytology (FNAC) and/or Core Biopsy (CB) from nodal metastases is required for diagnosis, comparison with primary tumour and to assess human papilloma virus (HPV) status. HPV positive biopsy from CUP may indicate oropharynx primary. HPV positive OPSCC has better prognosis. HPV association is ascertained by p16 immunocytochemistry (p16- IHC) and HPV DNA in situ hybridization (HPV-ISH). In a cohort of OPSCC patients from a single referral centre 68% had metastatic disease. Core biopsy was optimal for HPV testing.
Method
Retrospective review of records from Transoral Robotic Surgery (TORS) patients treated for OPSCC between December 2017-2019 was conducted. Cohort included patients undergoing TORS for diagnostic purposes and with curative intent.
Results
Data was available from 23 patients who had TORS for OPSCC. 47.8% (n = 11) presented with lymphadenopathy. 82.6% (n = 19) underwent FNAC. 68.4% (n = 13) were diagnosed with metastatic OPSCC and 56.5% (n = 13) underwent neck dissections. 52.2% (n = 12) had confirmed HPV positive metastases, 75% (n = 9) had 1 node positive, 25% (n = 3) had >1 node positive. FNAC yielded enough tissue for p16 IHC and HPV-ISH in 10.5% (n = 2). CB yielded sufficient tissue for analysis in all cases 39.1% (n = 9).
Conclusions
The study confirms high incidence of neck metastases in HPV associated OPSCC patients. Needle core biopsy appears superior to FNAC for tissue sampling to assess HPV status in tumours metastatic to neck.
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Affiliation(s)
| | - A Arora
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J P Jeannon
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Brunet-Garcia
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J Faulkner
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Sandison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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27
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Gao C, Al-Lami A, Al-Zuhir N, Simo R, Arora A, Jeannon JP. 1692 No Longer Unknown: A Systematic Review & Meta-Analysis of The Effectiveness of Trans-Oral Surgical Techniques in Identifying Head and Neck Primary Cancer in Carcinoma Unknown Primary. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
The use of transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and more recently reported transoral endoscopic electrocautery (TOEC) in the identification of the primary cancer in CUP patients has gained popularity. This systematic review aims to assess the effectiveness of TORS, TLM and TOEC.
Method
A systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting methodology was carried out to assess the effectiveness of the three trans-oral surgical techniques. EMBASE, MEDLINE and CINAHL databases were searched from inception to September 2020. Primary outcome measure was detection rates of primary cancer of the different techniques. Secondary outcome measures were complications and length of hospital stay.
Results
289 studies were identified of which 30 met the inclusion criteria (28 case series and 2 case reports). The overall combined primary identification rate was 72.3% (567 /777 patients). The primary identification rates were 49.7% and 34.2% in lingual (n = 273) and palatine tonsillectomy (n = 118) respectively. The primary cancer identification rates by surgical techniques are: TORS was 60% (CI 0.49, 0.70), TLM was 80% (CI 0.58, 1.01), TOEC was 41% (CI 0.05, 0.76). The commonest complication was haemorrhage (5.3%).
Conclusions
This is the largest systematic review in the subject and incorporates the more recently published surgical technique of TOEC. Lingual tonsillectomy is an effective procedure in CUP work up. Further larger, multi-centre, prospective studies of PET CT negative CUP patients is needed to draw conclusive results
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Affiliation(s)
- C Gao
- William Harvey Hospital, Ashford, United Kingdom
| | - A Al-Lami
- William Harvey Hospital, Ashford, United Kingdom
| | - N Al-Zuhir
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - R Simo
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - A Arora
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - J P Jeannon
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
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Kumar M, Kumar M, Kumar Jha A, Arora A. Snapshots Quiz. Br J Surg 2021; 108:1104. [PMID: 34160031 DOI: 10.1093/bjs/znab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/13/2022]
Abstract
A 55-year-old male presented with a 6 month history of multiple swellings on the right buttock and sacral region with yellowish discharge. The patient frequently walked bare foot, but denied any history trauma. Fine needle aspirate cytology showed acute dense inflammation, nuclear debris and numerous filamentous bacilli, which on staining revealed gram positive bacilli. What is the diagnosis?
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Affiliation(s)
- M Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - M Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - A Kumar Jha
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - A Arora
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
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29
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Rai A, Arora A, Jain A, Panneerselvam E. Modified vertical osteotomy cut in bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 2021; 59:965-967. [PMID: 34456077 DOI: 10.1016/j.bjoms.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
Bilateral sagittal split osteotomy (BSSO) is the most common orthognathic surgical procedure for the correction of facial deformities. Like any other surgical procedure, it is also associated with a risk of complications. One of these is described in the literature as notching at the lower inferior border of the mandible. Such discontinuity in the contour of the lower border is often a concern for patients. To overcome this complication, we recommend a modified vertical osteotomy cut while performing BSSO.
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Affiliation(s)
- A Rai
- Department of Dentistry, AIIMS, Saket Nagar, Bhopal, MP, India.
| | - A Arora
- Department of Oral and Maxillofacial Surgery, Shree Bankey Bihari Dental College & Research Centre, Ghaziabad, UP, India.
| | | | - E Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Chennai, India.
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30
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Raniga S, Parikh N, Arora A, Vaghani M, Vora PA, Vaidya V. Is HRCT reliable in determining disease activity in pulmonary tuberculosis? Indian J Radiol Imaging 2021. [DOI: 10.4103/0971-3026.29096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Aims and Objectives
The purpose of our study is to [1] determine the activity of disease based on the HRCT findings (2) to define indications for the use of HRCT in evaluation of Pulmonary TB and (3) to determine whether additional information provided by HRCT alters clinical management of the disease.
Materials and Methods
The present study was carried out at Shree Sayajirao General Hospital (SSGH), Baroda, Gujarat, India from January 2002 to December 2002. Twenty five patients with sputum positive post-primary pulmonary TB were studied prospectively with chest radiographs and HRCT. The diagnosis of active TB was based on detection of acid-fast bacilli in sputum. None of the patients in our study population was HIV positive. All patients underwent x-ray chest and HRCT chest (Philips Tomoscan, Best, Netherlands). The pattern, extent and severity of HRCT findings were recorded and compared with the plain x-ray findings. The gathered information and investigations were subjected to statistical analysis.
Results
Our study population consisted of sputum positive (AFB positive) 25 patients, 22 of them were newly diagnosed/suspected post-primary tuberculosis (GROUP 1) and 3 of them had taken six months of AKT (GROUP 2). Our study included 22 males and 3 females with average age of 38 years (range, 14-65 years.) In total chest radiographic signs of active tuberculosis were seen in twelve (48%) patients. HRCT showed evidences of active tuberculosis in all 22 patients of newly diagnosed tuberculosis; and in 2 out of 3 patients with prior history of AKT. Thus, total of 24 (96%) patients had evidence of active pulmonary TB on HRCT. One patient with prior history of AKT showed evidence of pulmonary Koch′s sequel.
Conclusion
Although chest radiography remains the foremost imaging technique in the evaluation of pulmonary TB, HRCT can be useful in certain circumstances and can provide important information in the diagnosis and management of the disease. HRCT is helpful in the distinction of active form inactive TB. HRCT is better than plain chest radiograph in identification of extent of pulmonary TB, especially subtle areas of consolidation, cavitation, bronchogenic and miliary spread. HRCT is recommended when the radiographic findings are normal or inconclusive and tuberculosis is suspected clinically for the confirmation of diagnosis and determination of activity.
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Affiliation(s)
- S Raniga
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - N Parikh
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - A Arora
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - M Vaghani
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - P A Vora
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - V Vaidya
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
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31
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Ramskold L, Lemaître S, Arora A. Iris metastasis from renal cell carcinoma. J Fr Ophtalmol 2021; 44:1278-1280. [PMID: 34353666 DOI: 10.1016/j.jfo.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L Ramskold
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom.
| | - S Lemaître
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom
| | - A Arora
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom
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32
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Mohta A, Jain SK, Mehta RD, Arora A. Development of eruptive pseudoangiomatosis following COVID-19 immunization - Apropos of 5 cases. J Eur Acad Dermatol Venereol 2021; 35:e722-e725. [PMID: 34236736 PMCID: PMC8447312 DOI: 10.1111/jdv.17499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Affiliation(s)
- A Mohta
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - S K Jain
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Kota, Rajasthan, India
| | - R D Mehta
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - A Arora
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
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33
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Pavan N, Kasivisvanathan V, Collins J, Kelkar A, Sridhar A, Shaw G, Rajan P, Kelly J, Briggs T, Sooriakumaran P, Nathan S. Salvage versus primary robot-assisted radical prostatectomy: A propensity-matched comparative effectiveness study from a high-volume tertiary center. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Arora A, McDonald C, Iansavitchene A, Brahmania M, Sey M. A65 ENDOSCOPIST-TARGETED INTERVENTIONS TO OPTIMIZE ADENOMA DETECTION RATE - A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adenoma detection rate (ADR) has emerged as the strongest quality assurance metric that has consistently been shown to be inversely associated with the development of colorectal cancer after colonoscopy. Unfortunately, marked variability in ADR exists among endoscopists. A multitude of interventions targeted at endoscopists to optimize their ADR have been reported, including but not limited to withdrawal time, in room observers, physician report cards, and quality improvement and training programs. However, it is unclear which of them are truly effective.
Aims
We performed a systematic review and meta-analysis of the literature to evaluate the effectiveness of endoscopist-targeted interventions to improve adenoma detection rate (ADR) or polyp detection rate (PDR).
Methods
Systematic searches of major databases were conducted through to March 2018 to identify potentially relevant studies. Both randomized controlled trials and observational studies were included. Data for ADR and PDR were analyzed on the log-odds scale using a random-effects meta-analysis model using restricted maximum likelihood (with Mantel-Haenszel fixed-effect meta-analysis used for fewer than 4 studies). Statistical effect-size heterogeneity was assessed using a Chi2 test and quantifying the relative proportion of variation using the I2 statistic. Publication bias was assessed by the Harbord regression test.
Results
From 4299 initial studies, 24 were included in the systematic review and 13 were included in the meta-analysis representing a total of 55,090 colonoscopies. Physician report card interventions (7 studies) and withdrawal time focused interventions (6 studies) were meta-analyzed. The pooled odds ratio for ADR for report card interventions was 1.31 (95% CI: 1.15, 1.50; p<0.0001), favoring report cards to detect more adenomas. Statistical heterogeneity was detected with substantial relative effect-size variability (Chi2, p<0.0001; I2=80.1%). No statistical evidence of publication bias was found. 6 studies reported data for PDR using withdrawal time focused interventions, with 3 of these reporting data on ADR. The pooled odds ratio for ADR was 1.02 (95% CI: 0.86, 1.22; p=0.81) and for PDR was 1.07 (95% CI: 0.88, 1.31; p=0.51) which were not statistically significant. Statistical heterogeneity was detected in both groups (Chi2, p<0.001; I2=82.2% for ADR and I2=89.4% for PDR) and there was statistical evidence of publication bias. Figures 1 and 2 represent Forest plots for the effect of pre-and post-report card and withdrawal time focused interventions on ADR.
Conclusions
Our study provides evidence that the distribution of colonoscopy quality report cards to physicians significantly improves overall ADR and should strongly be considered as part of quality improvement programs aimed at optimizing colonoscopy performance.
Funding Agencies
None
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Affiliation(s)
- A Arora
- Gastroenterology, Western University, London, ON, Canada
| | - C McDonald
- Gastroenterology, Western University, London, ON, Canada
| | | | - M Brahmania
- Gastroenterology, Western University, London, ON, Canada
| | - M Sey
- Western University, London, ON, Canada
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35
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Singh S, Bansal P, Arora A, Goel A. Esophageal adenocarcinoma with metastatic skin nodules and Budd-Chiari syndrome. J Postgrad Med 2021; 67:122-123. [PMID: 33818522 PMCID: PMC8253335 DOI: 10.4103/jpgm.jpgm_1319_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S Singh
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - P Bansal
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - A Arora
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - A Goel
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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36
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Takhar A, Tornari C, Amin N, Wyncoll D, Tricklebank S, Arora A, Ahmad I, Simo R, Surda P. Safety and outcomes of percutaneous tracheostomy in coronavirus disease 2019 pneumonitis patients requiring prolonged mechanical ventilation. J Laryngol Otol 2020; 134:1-10. [PMID: 33143760 PMCID: PMC7729174 DOI: 10.1017/s0022215120002303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT-anaesthetics department led tracheostomy team. METHOD A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020. RESULTS Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13-20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23-40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7-16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related. CONCLUSION Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation.
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Affiliation(s)
- A Takhar
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - C Tornari
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - N Amin
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - D Wyncoll
- Department of Critical Care, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - S Tricklebank
- Department of Critical Care, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - A Arora
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - I Ahmad
- Department of Anaesthesia, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - R Simo
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - P Surda
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
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Touska P, Oikonomou G, Ngu R, Chandra A, Malhotra A, Fry A, Oakley R, Arora A, Jeannon JP, Simo R. The role of transoral fine needle aspiration in expediting diagnosis and reducing risk in head and neck cancer patients in the coronavirus disease 2019 (COVID-19) era: a single-institution experience. J Laryngol Otol 2020; 134:1-8. [PMID: 32873344 PMCID: PMC7533497 DOI: 10.1017/s0022215120001929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The global coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid alterations to diagnostic pathways for head and neck cancer patients that aim to reduce risk to patients (exposure to the hospital environment) and staff (aerosol-generating procedures). Transoral fine needle aspiration cytology offers a low-risk means of rapidly diagnosing patients with oral cavity or oropharyngeal lesions. The technique was utilised in selected patients at our institution during the pandemic. The outcomes are considered in this study. METHOD Diagnostic outcomes were retrospectively evaluated for a series of patients undergoing transoral fine needle aspiration cytology of oral cavity and oropharyngeal lesions during the COVID-19 pandemic. RESULTS Five patients underwent transoral fine needle aspiration cytology, yielding lesional material in 100 per cent, with cell blocks providing additional information. In one case, excision biopsy of a lymphoproliferative lesion was required for final diagnosis. CONCLUSION Transoral fine needle aspiration cytology can provide rapid diagnosis in patients with oral cavity and oropharyngeal lesions. Whilst limitations exist (including tolerability and lesion location), the technique offers significant advantages pertinent to the COVID-19 era, and could be employed in the future to obviate diagnostic surgery in selected patients.
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Affiliation(s)
- P Touska
- Department of Radiology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - G Oikonomou
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Ngu
- Department of Dental Maxillofacial Imaging, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Chandra
- Department of Cellular Pathology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Malhotra
- Department of Cellular Pathology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Fry
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Oakley
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Arora
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - J-P Jeannon
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Simo
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
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Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, George A. Oral health care among patients with diabetes in Australia: A snapshot. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes increases the risk of periodontal disease, which in turn negatively impact on diabetes control and complications. Therefore, awareness about the diabetes-oral health link and dental problems is important for people with diabetes. This study aimed to assess self-reported oral health status and knowledge of people living with diabetes.
Methods
A survey was conducted among patients who attended four public diabetes clinics in Sydney, Australia. The questionnaire included 10 knowledge items and a validated Oral Health Impact Profile (OHIP-14) scale. A convenience sample of 200 patients were recruited. The data were analysed using SPSS software with descriptive and Pearson's Chi-Squared tests reported.
Results
The mean age of participants was 62.4(±13.5) years. More than half were males (54.5%), born overseas (64%), not working (73%) and had type 2 diabetes (88%). More than half (55.1%) of the patients reported having one or more dental problems and this was negatively associated with their oral health-related quality of life (p < 0.001). The most common dental problems were: gaps between teeth, pain in teeth and dry mouth. Only 46.2% of the participants had adequate oral health knowledge (> the mean correct score 5.2 (±2.6). The main areas with poor knowledge were around the impact of gum disease on blood glucose levels (29.6%), effects of dry mouth on tooth decay (33.8%) and the link between diabetes and teeth and gums (44.5%). Only 13% of the patients reported receiving oral health information from diabetes care providers (diabetes educator, general practitioner/diabetes specialist and dietitian/nutritionist). Receiving oral health information was found to be significantly associated with higher oral health knowledge scores (p < 0.05).
Conclusions
Considering that a majority of patients with diabetes have dental problems and inadequate oral health knowledge, diabetes care providers should take the opportunity to educate patients about oral health risks.
Key messages
People living with diabetes found to have dental problems and inadequate oral health knowledge. Considering that diabetes and dental problems adversely affect each other, it is crucial to educate patients about good oral hygiene and regular dental visit.
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Affiliation(s)
- P Poudel
- School of Nursing & Midwifery, Western Sydney University, Campbelltown, Australia
- Centre for Oral Health Outcomes and Research Translation, WSU, Ingham Institute for Applied Medical Research South Western Sydney Local Health District, Liverpool, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, Australia
| | - R Griffiths
- School of Nursing & Midwifery, Western Sydney University, Campbelltown, Australia
| | - V W Wong
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, Australia
- Diabetes and Endocrine Service, Liverpool and Fairfield Hospital SWSLHD, Liverpool, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - J R Flack
- Faculty of Medicine, University of New South Wales, Kensington, Australia
- Diabetes Centre Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Bankstown, Australia
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - A George
- School of Nursing & Midwifery, Western Sydney University, Campbelltown, Australia
- Centre for Oral Health Outcomes and Research Translation, WSU, Ingham Institute for Applied Medical Research South Western Sydney Local Health District, Liverpool, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, Australia
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Affiliation(s)
- A Arora
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
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40
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Amaral B, Macek P, Sanchez-Salas R, Linck Pazeto C, Zugail A, Arora A, Fregeville A, Marinho F, Lefevre M, Cathala N, Mombet A, Cathelineau X. Renal tumor biopsy: Rationale to avoid surgery in small renal masses. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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41
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Patel PA, Liang C, Arora A, Vijayan S, Ahuja S, Wagley PK, Settlage R, LaConte LEW, Goodkin HP, Lazar I, Srivastava S, Mukherjee K. Haploinsufficiency of X-linked intellectual disability gene CASK induces post-transcriptional changes in synaptic and cellular metabolic pathways. Exp Neurol 2020; 329:113319. [PMID: 32305418 DOI: 10.1016/j.expneurol.2020.113319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/04/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
Heterozygous mutations in the X-linked gene CASK are associated with intellectual disability, microcephaly, pontocerebellar hypoplasia, optic nerve hypoplasia and partially penetrant seizures in girls. The Cask+/- heterozygous knockout female mouse phenocopies the human disorder and exhibits postnatal microencephaly, cerebellar hypoplasia and optic nerve hypoplasia. It is not known if Cask+/- mice also display seizures, nor is known the molecular mechanism by which CASK haploinsufficiency produces the numerous documented phenotypes. 24-h video electroencephalography demonstrates that despite sporadic seizure activity, the overall electrographic patterns remain unaltered in Cask+/- mice. Additionally, seizure threshold to the commonly used kindling agent, pentylenetetrazol, remains unaltered in Cask+/- mice, indicating that even in mice the seizure phenotype is only partially penetrant and may have an indirect mechanism. RNA sequencing experiments on Cask+/- mouse brain uncovers a very limited number of changes, with most differences arising in the transcripts of extracellular matrix proteins and the transcripts of a group of nuclear proteins. In contrast to limited changes at the transcript level, quantitative whole-brain proteomics using iTRAQ quantitative mass-spectrometry reveals major changes in synaptic, metabolic/mitochondrial, cytoskeletal, and protein metabolic pathways. Unbiased protein-protein interaction mapping using affinity chromatography demonstrates that CASK may form complexes with proteins belonging to the same functional groups in which altered protein levels are observed. We discuss the mechanism of the observed changes in the context of known molecular function/s of CASK. Overall, our data indicate that the phenotypic spectrum of female Cask+/- mice includes sporadic seizures and thus closely parallels that of CASK haploinsufficient girls; the Cask+/- mouse is thus a face-validated model for CASK-related pathologies. We therefore surmise that CASK haploinsufficiency is likely to affect brain structure and function due to dysregulation of several cellular pathways including synaptic signaling and cellular metabolism.
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Affiliation(s)
- P A Patel
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, United States
| | - C Liang
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
| | - A Arora
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
| | - S Vijayan
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - S Ahuja
- Biological Sciences, Virginia Tech, Blacksburg, VA, United States
| | - P K Wagley
- Neurology, University of Virginia, Charlottesville, VA, USA
| | - R Settlage
- Advanced Research Computing, Virginia Tech, Blacksburg, VA, United States
| | - L E W LaConte
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
| | - H P Goodkin
- Neurology, University of Virginia, Charlottesville, VA, USA
| | - I Lazar
- Biological Sciences, Virginia Tech, Blacksburg, VA, United States
| | - S Srivastava
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
| | - K Mukherjee
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States; Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.
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Bernabe E, Marcenes W, Hernandez C, Bailey J, Abreu L, Alipour V, Amini S, Arabloo J, Arefi Z, Arora A, Ayanore M, Bärnighausen T, Bijani A, Cho D, Chu D, Crowe C, Demoz G, Demsie D, Dibaji Forooshani Z, Du M, El Tantawi M, Fischer F, Folayan M, Futran N, Geramo Y, Haj-Mirzaian A, Hariyani N, Hasanzadeh A, Hassanipour S, Hay S, Hole M, Hostiuc S, Ilic M, James S, Kalhor R, Kemmer L, Keramati M, Khader Y, Kisa S, Kisa A, Koyanagi A, Lalloo R, Le Nguyen Q, London S, Manohar N, Massenburg B, Mathur M, Meles H, Mestrovic T, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mokdad A, Morrison S, Nazari J, Nguyen T, Nguyen C, Nixon M, Olagunju T, Pakshir K, Pathak M, Rabiee N, Rafiei A, Ramezanzadeh K, Rios-Blancas M, Roro E, Sabour S, Samy A, Sawhney M, Schwendicke F, Shaahmadi F, Shaikh M, Stein C, Tovani-Palone M, Tran B, Unnikrishnan B, Vu G, Vukovic A, Warouw T, Zaidi Z, Zhang Z, Kassebaum N. Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study. J Dent Res 2020; 99:362-373. [PMID: 32122215 PMCID: PMC7088322 DOI: 10.1177/0022034520908533] [Citation(s) in RCA: 551] [Impact Index Per Article: 137.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank’s classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.
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Affiliation(s)
| | - E. Bernabe
- E. Bernabe, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Bessemer Road, London, SE5 9RS, UK.
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Arora A, Tsoi K. A199 BLACK ESOPHAGUS: AN UNDER-RECOGNIZED CAUSE OF UPPER GASTROINTESTINAL BLEEEDING. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
“Black esophagus” is a term that refers to the endoscopic manifestation of acute esophageal necrosis (AEN), a rare but potentially under-recognized cause of upper gastrointestinal bleeding, characterized by the presence of strikingly black necrotic esophagus on upper endoscopy. The etiology is unclear although ischemic insults and caustic injury from gastric acid exposure are thought to play prominent roles. This condition is often seen in patients who are systemically unwell and have underlying comorbidities such as diabetes mellitus and vascular diseases.
Aims
We present a case of an elderly woman with diabetes and poor glycemic control who developed coffee ground emesis with her upper endoscopy revealing evidence of acute esophageal necrosis. AEN is an important diagnosis to consider in diabetic patients, as it generally carries a poor prognosis with mortality rates as high as 32% reported in the literature.
Methods
Case report and review of the literature
Results
A 61-year-old woman with medical history significant for poorly controlled insulin dependent diabetes (hemoglobin A1c, 11%) developed coffee ground emesis (confirmed via insertion of nasogastric tube) three days after initial admission to hospital for left tibial plateau fracture. Her bloodwork did not reveal any underlying diabetic ketoacidosis or hyperosomlar hyperglycemic state. Her esophagogastroduodenoscopy (EGD) showed black, necrotic-appearing discoloration of the esophageal mucosa circumferentially within the mid to distal part of the esophagus with a sharp transition point towards normal appearing mucosa at the gastroesophageal junction. Biopsies were deferred due to high risk of bleeding and perforation, and the previously placed nasogastric tube was not removed.
After endoscopy, conservative management was advised with restricted oral intake, intravenous proton pump inhibitor (PPI) inhibitor therapy for 72 hours and aggressive treatment of ongoing hyperglycemia. There were no signs or symptoms of esophageal rupture. The patient gradually recovered and in fact had her orthopedic surgery within a week of EGD. Furthermore, three days into the post operative period she developed venous thromboembolism and was placed on full dose oral anticoagulation and tolerated this without any further gastrointestinal bleeding.
Conclusions
AEN is an important diagnostic consideration in elderly diabetic patients presenting with acute upper gastrointestinal bleeding, particularly as timely recognition and management can significantly lower the unfavorable mortality associated with this condition.
Funding Agencies
None
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Affiliation(s)
- A Arora
- Gastroenterology, Western University, London, ON, Canada
| | - K Tsoi
- Medicine, McMaster University, Hamilton, ON, Canada
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Affiliation(s)
- I. Ahmad
- Department of Anaesthesia Guy's and St Thomas NHS Foundation Trust London UK
- King's College London UK
| | - A. Arora
- Department of Surgery Guy's and St. Thomas NHS Foundation Trust London UK
| | - K. El‐Boghdadly
- Department of Anaesthesia Guy's and St Thomas NHS Foundation Trust London UK
- King's College London UK
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Sadiq M, Khan S, Lopez-Escola C, Arora A, Hennig I, Abdallah S, Soomro I. Experience with osimertinib in second-line treatment of non-small cell lung cancer at Nottingham University Hospitals. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Klump SP, Allred MC, MacDonald JL, Ballam JM, Arora A, Cole S, Collison M, Ellefson W, Gensic J, Hazebroek J, Johns P, Klump S, Lewis S, Moghaddam M, Murphy P, Woollard DC. Determination of Isoflavones in Soy and Selected Foods Containing Soy by Extraction, Saponification, and Liquid Chromatography: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.6.1865] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Isoflavones are biologically active compounds occurring naturally in a variety of plants, with relatively high levels found in soybeans. Twelve laboratories participated in a collaborative study to determine the aglycon isoflavone content of 8 test samples of soy and foods containing soy. The analytical method for the determination of isoflavones incorporates a mild saponification step that reduces the number of analytes measured and permits quantitation versus commercially available, stable reference standards. Test samples were extracted at 65°C with methanol–water (80 + 20), saponified with dilute sodium hydroxide solution, and analyzed by reversed-phase liquid chromatography with UV detection at 260 nm. Isoflavone results were reported as μg/aglycon/g or μg aglycon equivalents/g. The 8 test samples included 2 blind duplicates and 4 single test samples with total isoflavone concentrations ranging from approximately 50 to 3000 μg/g. Test samples of soy ingredients and products made with soy were distributed to collaborators with appropriate reference standards. Collaborators were asked to analyze test samples in duplicate on 2 separate days. The data were analyzed for individual isoflavone components, subtotals of daidzin–daidzein, glycitin–glycitein, and genistin–genistein, and total isoflavones. The relative standard deviation (RSD) for repeatability was 1.8–7.1%, and the RSD for reproducibility was 3.2–16.1% for total isoflavone values of 47–3099 μg/g.
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Affiliation(s)
- Stephen P Klump
- Ralston Analytical Laboratories, One Checkerboard Square, 2RN, Saint Louis, MO 63164
| | - Maryann C Allred
- Ralston Analytical Laboratories, One Checkerboard Square, 2RN, Saint Louis, MO 63164
| | - John L MacDonald
- Ralston Analytical Laboratories, One Checkerboard Square, 2RN, Saint Louis, MO 63164
| | - Joan M Ballam
- Ralston Analytical Laboratories, One Checkerboard Square, 2RN, Saint Louis, MO 63164
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Arora A, Saxena A, Jaiswal E, Teja GND. 2576 Right Sided Cornual Ectopic Pregnancy after Right Salpingectomy. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Saravia D, Basher F, Arora A, Soong D, Fanfan D, Cotta J, Lopes G. P2.06 Lung Cancer Driver Mutations and PD-L1 Expression in US Latino Patients with Advanced Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Arora A, Saxena A, Jaiswal E, Teja GND, Srivastava G. 2512 Extra Peritoneal Sling Surgery vs Pectopexy in Nulliparous Prolapse. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Saxena A, Arora A, Jaiswal E, Teja GND. 2579 Isthmocele in a Patient with Secondary Infertility. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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